右美托咪定复合地佐辛静脉镇痛对老年患者腹腔镜术后认知功能的影响*

Effects of Dezocine combined with Dexmedetomidine for postoperative cognitive dysfunction in elderly patients after laparoscopic cholecystectomy*

摘要:

摘要：目的 观察右美托咪定复合地佐辛静脉镇痛对老年患者腹腔镜胆囊切除术后认知功能的影响。方法 择期行腹腔镜胆囊切除术的老年患者40例，随机分为右美托咪定复合地佐辛镇痛组D组和舒芬太尼镇痛组C组两组，每组各20例。术后D组地佐辛0.4 g/kg和右美托咪定200.0 mg配制成100 ml持续静脉泵注；C组舒芬太尼3μg/kg配制成100 ml持续静脉泵注。观察并记录术后2、4、8、24和48 h时患者的疼痛视觉模拟评分（VAS）和Ramsay镇静评分，于术前1 d、术后1、3和5 d使用简易智能量表（MMSE）进行患者术前术后的神经心理学评估。结果 D组患者在术后各时点的VAS评分与C组无差异（P >0.05），Ramsay评分在4、8和24 h均明显低于C组（P <0.05）；D组患者术后1和3 d的MMSE评分低于术前1 d（P <0.05），且在术后1和3 d明显高于C组（P <0.05）；D组术后认知功能障碍（POCD）的发生率在术后1和3 d明显小于C组（P <0.05）。结论 右美托咪定复合地佐辛应用于老年患者腹腔镜胆囊切除术后镇痛，不但镇痛镇静效果好，还能减少POCD的发生。

Abstract:

Abstract: Objective To investigate the effects of Dezocine combined with Dexmedetomidine for postoperative analgesia and early postoperative cognitive dysfunction (POCD) in elderly patients after laparoscopic cholecystectomy. Method 40 elderly patients underwent elective laparoscopic cholecystecom were randomly divided into D group and C group (n = 20), all the patients underwent patient-controlled intravenous analgesia (PCIA). In D group Dezocine 0.4 g/kg and Dexmedetomidine 200.0 mg were diluted with normal saline to 100 ml; in C group Sufentanil 3 μg/kg were diluted with normal saline to 100 ml. Visual Analogue Score (VAS score) and Ramsay score after operation 2 h, 4 h, 8 h, 24 h, 48 h were be evaluated. Cognitive function was assessed preoperatively and 1 day and 3, 5 days postoperatively using mini mental state examination (MMSE). Results There was no significant difference in VAS score between group D and group C (P > 0.05). Compared with group C, Ramsay score of group D was significantly lower at 4, 8 and 24 hours after operation (P < 0.05). MMSE scores on the 1 day and 3 days postoperatively were significantly lower than that preoperatively in group D (P < 0.05), and significantly higher than that in group C (P < 0.05). The incidence of POCD on the 1 day and 3 days postoperatively were significantly lower in group D than that in group C (P < 0.05). Conclusion PCIA with Dezocine combined with Dexmedetomidine is more effective than Sufentanil for elderly patients after laparoscopic cholecystectomy, and can decrease the incidence of POCD.